Using weight-loss drugs after bariatric surgery is safe and effective in people who don’t lose weight after a gastric sleeve or bypass, a new Australian study has found.
The results of a new study are encouraging for people who have previously undergone bariatric surgery but failed to lose weight.
As many as 15% of people who undergo metabolic bariatric surgery experience suboptimal weight loss after the procedure.
These patients often require further surgery, which is associated with increased risks and reduced weight loss compared to the initial surgery.
The development of obesity management medications such as liraglutide presents an alternative, non-surgical treatment option for people who are unable to lose weight after going under the knife.
And now, new Australian research, suggests that compared to placebo, liraglutide resulted in greater weight loss in a people with a suboptimal response to metabolic bariatric surgery. The findings were published in JAMA Network Open.
“We are the first to show that the full dose of obesity management medication may not be needed in the post-bariatric surgery setting, and importantly, quality of life is not affected by introducing the obesity management medication,” said lead author Professor Wendy Brown, head of the Department of Surgery at Monash University and director of the Oesophago-Gastric-Bariatric Unit at The Alfred.
“This raises the possibility of avoiding risky repeat surgery which is the current main option when people need more weight loss after bariatric surgery.”
Researchers recruited 48 individuals aged 20-65 years who had previously undergone metabolic bariatric surgery (either adjustable gastric banding followed by a sleeve gastrectomy, an anastomosis gastric bypass or a Roux-en-Y-gastric bypass), had a BMI of at least 35 and had either suboptimal weight loss or weight gain post-procedure.
Participants were randomised to receive either liraglutide or placebo. Liraglutide doses started at 0.6mg, escalating to 3.0mg over a five-week period.
All participants also completed an educational intervention designed at improving eating styles and behaviours.
After 12 months of treatment, participants in the liraglutide group had lost an average of 4.4% of their baseline weight, whereas participants in the placebo group had gained an average of 1.4% of their initial weight.
This corresponds to an average weight loss of 5.7kg for patients who received liraglutide, and an average weight gain of 1.4kg for patients receiving placebo.
Patients in the liraglutide group displayed a small increased in diastolic blood pressure after 12 months of treatment (82mmHg compared to 78mmHg at baseline), but no such difference was observed in the placebo group.
Minor differences in self-reported quality of life were noted; the liraglutide group reported lower levels of pain compared to the placebo group, but the placebo group had greater physical function.
No differences in other secondary outcomes, including other measures of nutrition and health (e.g., cholesterol, triglycerides or vitamin levels), were observed between baseline and the 12-month follow-up or between treatment groups.
Professor John Wentworth, an endocrinologist at the Royal Melbourne Hospital and joint senior author on the new study, was excited by the results.
“Our demonstration that incretin drugs enhance weight loss following bariatric surgery provides great hope. Excitingly, newer, more effective drugs have become available and should help our patients achieve even better weight and health outcomes.”
Adjust Associate Professor Paul Burton, an upper gastrointestinal surgeon from the Monash University Department of Surgery and co-author on the study, was similarly excited by the potential benefits of turning to obesity management medications rather than additional surgery.
“The results reinforce that personalised treatment, careful patient selection, sustained lifestyle change, and ongoing adherence are essential to managing obesity as a lifelong disease we can remit but not cure,” he said.
“There are no quick fixes, but we now have increasingly effective, evidence-based treatment options. These findings support a personalised, long-term strategy that pairs surgical expertise with medication, lifestyle support and ongoing engagement to achieve durable remission rather than a cure.”
